One-Year Outcomes of Orbital Versus Rotational Atherectomy for the Treatment of Heavily Calcified Coronary Disease

Background:
Plaque modification has facilitated successful stent delivery and optimization in severely calcified coronary arteries. The two approved atherectomy modalities are rotational atherectomy (RA) (Boston Scientific) and orbital atherectomy (OA) (CSI Diamondback 360®). No previous studies have compared 1-year outcomes in patients undergoing RA and OA.

Methods:
We identified 75 patients who underwent RA or OA, and had at least 1-year follow up, at a single veteran center from 2016 to 2017. The primary endpoint was 1-year major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stroke). The secondary endpoint was cardiac death at 1 year.

Results:
Of the 75 patients who received an atherectomy, 46 underwent RA and 28 underwent OA. Baseline demographics were similar in both groups; there were no differences in age (70±6.7 vs 70.5±6.9, p=0.72), BMI (30.6±5 vs 30.1±5.3, p=0.68), race, or gender. More patients in the RA group had a prior MI (45.8% vs 20.7%, p=0.03). All other baseline comorbidities were similar between groups. There was no significant difference in the number of patients with severe triple-vessel disease or equivalent, or severe left main disease (47.83% vs 41.38%, p=0.76). The most common presentation was unstable angina (41.7% vs 55.2%, p=0.35) followed by heart failure (27.1% vs 20.7%, p=0.59). Procedural success was achieved in all patients. Angiographic complications were uncommon (4.2% vs 3.5% dissection, P>0.9; 0% vs 0% perforation, p>0.9; 2.1% vs 0% slow flow/no reflow, p>0.9) in the RA and OA groups. The primary endpoint at one year was also similar in both RA and OA groups, respectively (26% vs 10.7%, p=0.19), as were the individual endpoints of all-cause-mortality (13% vs 7.14%, p=0.52), MI (10.87% vs 0%, p=0.15), TVR (13% vs 7.1%, p=0.7), and stroke (0% vs 3.5%, p=0.38). No significant difference in cardiac death at 1 year was observed between groups (8.69% vs 3.57%, p=0.64).

Conclusions:
RA and OA are equally effective in facilitating stent delivery in heavily calcified coronary arteries and demonstrate similar outcomes at one year.